Study on covert administration of medications practices among persons with severe mental illness: A cross-sectional study

Background: Covert administration of medication (CoAdM) by caregivers to persons with severe mental illness (SMI) is a commonly observed medication delivery practice in India. Aims: This study aims to examine different medication delivery practices adopted by caregivers to provide care to SMI at times of medication refusal. Method: This study was conducted at the outpatient department between April 2019 and November 2019. A semi-structured questionnaire was used to interview the caregivers of persons with SMI to assess medication delivery practices. Results: A total of 300 caregivers were interviewed. CoAdM was practiced in 96 (32.0%) persons with SMI at least once during their lifetime, and other strategies used were pleading ( n = 105, 35.0%), lying ( n = 10, 3.3%), and threatening ( n = 154, 51.4%). Logistic regression showed that male gender (OR 4.75; CI 1.37–16.46), absent insight (OR 10.0; CI 2.01–47.56), and poor adherence to medication (OR 4.75; CI 1.31–16.92) were significantly associated with CoAdM in the last 1 year. Caregivers perceived significant improvement in self-care ( Z = −4.37, p < .01), interpersonal ( Z = −7.61, p < .01), work ( Z = −5.9, p < .01), family functioning ( Z = −7.82, p < .01) difficult behavior ( Z = −8.27, p < .01), and dependency ( Z = −6.34, p < .01) in persons with SMI with use of CoAdM. Conclusions: CoAdM was given to one in three persons with SMI at some point in their lives. Male gender, absent insight and poor adherence were predictive of CoAdM in the last 1 year. Caregiver perceived improvements in self-care, work, interpersonal, family functioning, problem behaviors, and dependency after CoAdM. Policies need to be evolved to serve all stakeholders while keeping these practices in mind.

Oxytocin Regimens for Labour Augmentation and Its Effect on Perinatal Outcomes: A Narrative Review

Background: The issue of childbirth, stimulation of labor is very important for successful childbirth and the birth of healthy babies. Obstetricians play main role in providing and rising Maternal and Child Health (MCH) care facilities. One amongst the goal of MCH care is safe delivery with smart feto-maternal outcome. The hormone plays vital role to cut back rates of caesarean birth once used for management of dystocia. Interventions with oxytocin particularly at high doses would lead to adverse effects on fetal heart rate and uterine tachsystole which occurs due to reduction in blood flow during contraction in intervillousspaces. The purpose of use of oxytocin is for physiological birth and for successful delivery practices. For augmentation of labour hormone regimens are low-dose (1-3 milli units/min) and high dose (4-7 milli units/min). Studies have shown high-dose of hormone causes hyperstimulation to womb. It's been mentioned that there's decrease in induction to delivery time at meta-analysis. Augmentation of labour is that the method of accelerating the frequency of contractions to facilitate a labour. The principal methodology for achieving augmentation of labour varies in the use and approach. Oxytocin is widely used for each induction and augmentation of labour. Interventions with oxytocin particularly at high doses would lead to adverse effects on fetal heart rate and uterine tachsystole which occurs due to reduction in blood flow during contraction in intervillous spaces. The purpose of use of oxytocin is for physiological birth and for successful delivery practices. These results reinforce the need to reflect on a change in care during delivery. Thus,this will help health care professional for better understanding on use and its effect during labour which will help in proper decision making for augmentation of labour.

Assessing health system factors affecting access and delivery of IPTp-SP and ITN to pregnant women attending ANC clinics in Ghana

Introduction Malaria interventions including use of Sulfadoxine-Pyrimethamine as Intermittent Preventive Treatment (IPTp-SP) and distribution of Insecticide Treated Nets (ITNs) have been implemented through ante-natal clinic (ANC) services in Ghana. Yet, the high ANC attendance is not commensurate with the uptake of these interventions, with missed opportunities to deliver the interventions. This study sought to assess the health system factors affecting access and delivery of IPTp-SP and ITN as defined by the Ghana Malaria Policy Guideline to eligible pregnant women attending ANC clinic sessions. Methods A quantitative cross-sectional study was conducted in the Volta Region of Ghana, with data collected across three levels of health care delivery facilities, including hospitals, health centres and Community-Based Health Planning Service (CHPS) compounds. Data collection included structured observation checklists to document the communication and interaction between the ANC health staff and pregnant women. Additionally, structured questionnaires were used to elicit information on cadre, trainings attended, knowledge and delivery practices of health workers on IPTp-SP and ITN. Stata 16 was used for data analysis, and a defined delivery algorithm was used to compute appropriate and inappropriate delivery practices, using the Ghana policy directive as a guide. Predictors of appropriate delivery were determined using logistic regression analysis. Results Approximately 97% of the 680 ANC observations had complete information for analysis. Of these, 78% (511/657) were eligible for IPTp-SP after excluding women who have less than 16 weeks of gestation, G6PD deficient, malaria positive and have taken 5 doses of IPTp-SP prior to day of observation. Appropriate delivery of IPTp-SP was 76% (390/511). Despite the availability of SP, 15% (75/511) of all eligible women were not offered the medication and 37% (44/119) of inappropriate delivery was recorded during periods of stock out. ITNs were appropriately delivered to 59% (139) out of 237 eligible women. Thirty-two percent (77/237) of eligible women, mostly continuing ANC clients, were not given ITN despite stock availability. Conclusions IPTp-SP was appropriately delivered to most of the eligible pregnant women compared to ITN. While stock out of both intervention could account for inappropriate delivery, despite stock availability, IPTp-SP and ITN were not delivered to some eligible women.

Influenza Vaccination in Massachusetts Jails: A Mixed-Methods Analysis

Objectives Influenza infects millions of people each year and contributes to tens of thousands of deaths annually despite the availability of vaccines. People most at risk of influenza complications are disproportionately represented in people incarcerated in US prisons and jails. The objectives of this study were to survey health administrators in Massachusetts county jails about institutional influenza vaccine policies and practices and estimate influenza vaccination rates in Massachusetts jails from 2013 to 2020. Methods In April 2020, we administered surveys to the health services administrators in Massachusetts’ 14 county jails to gather information about influenza vaccination policies and delivery practices. To calculate influenza vaccination rates for each facility, we obtained data on influenza vaccine orders from the Massachusetts Department of Public Health for each county in Massachusetts for influenza seasons 2013-2020. We calculated summary statistics for each reporting facility and each year, conducted a Kruskal–Wallis analysis to compare vaccination rates between years, and used a linear regression model to identify predictors of vaccination rates. Results Influenza vaccination rates in Massachusetts jails ranged from 1.9% to 11.8%. We found no significant differences in vaccination rates between years. Influenza vaccine ordering and delivery practices varied by jail, and respondents had high levels of confidence in influenza policies and vaccine delivery practices. Conclusions Influenza vaccination rates in Massachusetts jails are low, and delivery practices in jails vary. Lack of influenza vaccinations in jails is a gap in health care that needs to be prioritized, especially considering the current COVID-19 pandemic. Further investigations for effective and equitable vaccination in this population should involve people who are incarcerated and people who make influenza vaccine policies in jails.

Effect of Socio-demographic Status, Knowledge, and Attitude on Utilisation of Safe Delivery Practices among Mothers of Children attending Child Welfare Clinics in Osogbo, Nigeria

Background: Previous studies on attendance at delivery by skilled personnel have neglected childbearing women’s knowledge and attitude towards safe delivery practices. This study assessed factors influencing utilisation of safe delivery services among mothers of under-five children attending child welfare clinics in Osogbo. Methods: This was a cross-sectional study conducted at child welfare clinics in Osogbo, Nigeria. Respondents were selected using a multistage sampling technique. Data was collected using a semi-structured, interviewer-administered questionnaire and analysed using Statistical Package for Social Sciences version 23. Statistical association between safe delivery practices and socio-demographic factors, knowledge of and attitude towards safe delivery practices were determined using logistic regression and p-value <0.05 was considered statistically significant. Results: Four hundred out of the 420 eligible respondents completed the questionnaire giving a response rate of 95.2%. More than half of the respondents; 223 (55.8%) were < 30 years old. Many respondents; 193 (48.3%) and their spouses; 229 (57.2%) had attained tertiary education. Almost all respondents; 389 (97.3%) attended antenatal care during their last pregnancies. Utilisation of skilled birth attendants was associated with antenatal clinic attendance in last pregnancy (p<0.001). Conclusion: The factors associated with utilisation of safe delivery services were respondent’s ages, educational attainment of the respondents and their spouses, and respondents’ attendance at antenatal clinic in last pregnancy. Implementation research on measures to promote antenatal and delivery services by skilled birth attendants is needed in order to increase utilisation of safe delivery practices by mothers.